TUBERCULOSIS

February 2016
Definition
 Tuberculosis is an infectious disease that affects the
lung parenchyma. It can affect other organs such as
the kidneys, heart and brain, bones and lymph
nodes (Brunner& Suddarth)

Etiology

 The causative agent is M tuberculosis acid fast-bacilli

Incidence and Prevalence
WHO 2016
Tuberculosis is the 10th leading cause of death world
wide
 10.4 million people contracted T.B

 1.7 million died with T.B

Incidence
Barbados

 Estimated 1.2 cases for every 100,000

www.who.intl/tb/country/data/profiles/en
Incidence and Prevalence
 It is leading cause of death (Infectious agents)
Related to delays in reporting and contacting persons
with the infection, foreign born residents and many
people who have latent TB.
Risk Factors
 Tuberculosis is a public health problem and is
associated with poor living conditions, over
crowding, poor housing, poverty, malnutrition, and
inadequate health care
Risk Factors
 Transmission by droplet infection (Droplet nuclei)
 Coughing sneezing laughing

 Susceptible persons
 Immuno compromised those using drugs that depress the
immune system
 Diabetes
 Chronic renal failure
 Cancer
 Dialysis
Risk factors
 Prolonged contact with a person with active TB
 I.V drug users
 Persons who do not have health
care(impoverished)persons under 15 years and
adults 15- 44
Risk Factors
 Immigrants
 Persons who live in impoverished areas
 Health care workers performing high risk activities
 Suctioning

 Collecting sputum samples

Pathophysiology
1. A susceptible host inhales the mycobacteria (acid
fast bacilli)
2. Transmitted to the alveoli
3. The bacilli travels through the Blood stream,
lymph system through the body to the heart,
brain, kidneys and bones.
4. This action initiates the inflammatory system
Pathophysiology
5. Phagocytes and neutrophils and macrophages
engulf the bacteria but they also destroy the good
tissue
6. Which results in exudate being accumulated in the
alveoli
7. Broncho pneumonia 2-10 weeks
8. A protective wall is formed by granulomas, new
tissue masses of live and dead bacilli –which is
eventually changed to a fibrous tissue mass
(GHON –Tubercule)
Pathophysiology
 9. This fibrous material eventually becomes necrotic
– forming a cheesy mass.
 10.The mass then may become calcified and form a
scar
 11.After the initial active disease the bacilli may
become dormant.
Path physiology
 12.After the initial infection. The bacilli maybe re-
activated because of a weakened immune system
 13. The Ghon- tubercle will be activated and
releases the cheesy material into the bronhi and
the bacilli is released into the atmosphere
 14. The process begins again and the lung
becomes more infected.
Pathophysiology
 Approximately 10 percent of persons who are
infected will develop active disease. Some will
develop reactivation of the disease (Adult type TB
Clinical Manifestations
 Low grade fever
 Night sweats
 Fatigue weight loss
 Productive cough-mucopurulent
 Non productive cough
 hemoptysis
Clinical Manifestations
 Both systemic and pulmonary are chronic
 Extra pulmonary disease can occur in 16 percent of
patients
 Extra pulmonary disease is more common in persons
with AIDS
Assessment and Diagnostic findings
 History
 Physical examination
 Sputum cultures acid fast bacilli
 Chest x-ray
 Tuberculin skin
Assessment and Diagnostic findings
 Tuberculin – skin test Mantoux
 Interpretation
 Induration and erythema
 Induration of 0-4mm is not considered significant

 5mm may be significant with patient who are

considered at risk ( Imunodeficency)
 10 mm is considered significant especially those
persons who have an altered immune system
Assessment and Diagnostic findings
 All person with a significant positive reaction may
not develop active disease.
 But all person who have a significant positive
reaction have a susceptibility of developing active
disease.
Assessment and Diagnostic findings
 QuantiFERON-TB Gold results are available in less
than 24 hours
Assessment and Diagnostic findings
 A diagnosis is made from history, physical
examination, chest x-ray, tuberculin test (graded
and classified from 1-5)
Medical Management (page 570)
 Pulmonary TB with antituberculosis agents drugs for
about 6-12 months
 Drug resistance is a problem
Pharmacologic Therapy
 First line Drugs
 INH Isoniazid
 Rifampin

 Pyrazinamide

 Ethambutol(Myambutol)

 Used in combination 8-12 weeks twice a week

 Continuous course of treatment 4-7 months
 People are considered non infectious after 2 months
continuous of treatment.
Pharmacologic Therapy
 Prophylatic treatment may be issued for persons
who are at risk
 Persons in a house hold with active disease
 Persons who are HIV positive and have a positive TB
skin test reaction
 Those who have a positive test and show changes from
the first test
 Users of I.V/ injection users- with 10mm or more
Pharmacologic Therapy
 Patients with co-morbid conditions and a skin test of
more than 10mm induration
 Persons 35 years or younger who have a positive
skin test 10mm induration or more who are from
areas with high incidence of TB
 Institutionalized patient
 High risk medical patient
Nursing Process
History
 Living arrangements

 Clinical symptoms

 Night sweats

 Cough

 Fever

 Fatigue

 Anorexia

 Weight loss
Nursing process
 Physical Examination
 Lungs sounds
 Consolidation
 Enlarged painful lymph nodes
Nursing Diagnosis
 Ineffective airway clearance
 Activity intolerance
 Deficient knowledge about treatment regimen
Nursing Diagnosis
 Potential Problems
 Malnutrition
 Adverse side effects from medication
 Multi drug resistance
Goals
 Maintain and a patent airway
 Increase knowledge about the disease and
treatment regimen
 Increased activity tolerance
Interventions
Promoting Airway clearance
 Increase the fluid intake

 Correct positioning

Promoting activity and Adequate Nutrition

 Progressively increase activity

 Exercises that promote muscle strength

Interventions
Promoting Adequate Nutrition
 Small frequent meals

 Use liquid supplement

 High caloric

 High protein

 Dietitian involved with meal planning

Interventions
Adherence to Treatment Regimen
 Ensure patient understands the schedule side effects

of the medications
 Maintain oral hygiene

 Cover mouth when sneezing and coughing

 Proper tissue disposal

 Hand washing
Interventions
 Teach about taking medications on empty stomach
or I hour before meals because food delays the
absorption of the medication.
 Patients taking Isoniazid(INH) avoid foods such as
aged cheese, red wine, soy sauce, yeast extracts-
cause flushing, hypotension and diaphoresis,
palpitations, headaches
Interventions
 Rifampin can cause a an increase in metabolism of
certain drugs
 Warfarin

 Coumadin

 Oral hypoglycemic agents

 Beta blockers

 Oral contraceptives

 corticosteriods
Interventions
 Causes discolouration
 ofurine
 Contact lens

 Monitor for other side effects

 Hepatitis

 Hearing loss
 Kidney failure – BUN Creatinine

 Monitor sputum for acid fast bacilli for effectiveness

of treatment
Interventions
 Community Care
 The nurse evaluates the patient’s environment
 Identifies persons who have been in contact with the
person during the infectious stage and arranges for
screening
 Monitors for any side effects of the medication
 Emphasizes the adherence to medications
 Emphasizes the importance of attending scheduled
appointments
References
All notes taken from
Smeltzer.S.C.,Bare.B,G.,Hinkle.J,L., Cheever.K,H.
Brunner & Suddarth’s Text Book of Medical-
Surgical Nursing. Lippincott Williams & Willins
2008.
Bickley.L,S Bates Guide to Physical Examination and
History Taking. Lippincott Williams & Willins 2008.
8th Edition